As we all know antiplatelets are the first choice in acute myocardial infarction.Every body uses aspirin and clopidogrel.
Aspirin acts by inactivating cox enzyme irreversibly of both activated and inactivated platelets. As platelets doesnot have a nucleus it cannot synthesise any new enzymes. So aspirin has the disadvantage of causing haemorrhage.
Clopidgrel acts by competing with ADP.It is not a potent platlet inhibitor when used alone.My vote then goes to a drug which blocks the activated platelets only but fully. It is none other than glycoprotein 2b3a inhibitor. It blocks the platelet aggregation effectively and adhesion partially. Like proton pump inhibitors which block the final pathway and releive us from gastric ulcers, this drug inhibits the final common pathway whenever platelets are activated. One such drug which i am following during my internship is tirobifan(aggramed).
It is very effective in NSTEMI. Hope in the future it will be used like aspirin as we use now. i will add to the above text when my study on tirobifan gets exciting.
AGGRASTAT* (tirofiban hydrochloride), a non-peptide antagonist of the platelet glycoprotein (GP) IIb/IIIa receptor, inhibits platelet aggregation.
Tirofiban hydrochloride monohydrate, a non-peptide molecule, is chemically described as N- (butylsulfonyl)-O-[4-(4-piperidinyl)butyl]-L-tyrosine monohydrochloride monohydrate. Its molecular formula is C22H36N2O5SHClH2O.
Tirofiban hydrochloride monohydrate is a white to off-white, non-hygroscopic, free-flowing powder, with a molecular weight of 495.08. It is very slightly soluble in water.
AGGRASTAT Injection Premixed is supplied as a sterile solution in water for injection, for intravenous use only, in plastic containers. Each 500 mL of the premixed, iso-osmotic intravenous injection contains 28.09 mg tirofiban hydrochloride monohydrate equivalent to 25 mg tirofiban (50 mcg/Ml) and the following inactive ingredients: 4.5 g sodium chloride, 270 mg sodium citrate dihydrate, and 16 mg citric acid anhydrous. The pH ranges from 5.5 to 6.5 and may have been adjusted with hydrochloric acid and/or sodium hydroxide.